title: A national cholera epidemic with high case fatality rates--Kenya 2009.
abstract: BACKGROUND
  Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response.
  
  
  METHODS
  We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts.
  
  
  RESULTS
  In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs.
  
  
  CONCLUSIONS
  High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.
authors.affiliation: Epidemic Intelligence Service, Office of Workforce and Career Development.
authors.forename: Anagha
authors.initials: A
authors.lastname: Loharikar
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Briere
authors.forename: Maurice
authors.initials: M
authors.lastname: Ope
authors.forename: Daniel
authors.initials: D
authors.lastname: Langat
authors.forename: Ian
authors.initials: I
authors.lastname: Njeru
authors.forename: Lucy
authors.initials: L
authors.lastname: Gathigi
authors.forename: Lyndah
authors.initials: L
authors.lastname: Makayotto
authors.forename: Abdirizak M
authors.initials: AM
authors.lastname: Ismail
authors.forename: Martin
authors.initials: M
authors.lastname: Thuranira
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abade
authors.forename: Samuel
authors.initials: S
authors.lastname: Amwayi
authors.forename: Jared
authors.initials: J
authors.lastname: Omolo
authors.forename: Joe
authors.initials: J
authors.lastname: Oundo
authors.forename: Kevin M
authors.initials: KM
authors.lastname: De Cock
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Tracy
authors.initials: T
authors.lastname: Ayers
authors.forename: Eric
authors.initials: E
authors.lastname: Mintz
authors.forename: Ciara E
authors.initials: CE
authors.lastname: O'Reilly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000401:mortality*; D058872:Epidemics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult
keywords: Kenya; cholera; nomadic/semi-pastoral; outbreak; sanitation; water